Healthcare Provider Details

I. General information

NPI: 1811525397
Provider Name (Legal Business Name): ANNA SALIBI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 E HUNT HWY
SAN TAN VALLEY AZ
85143-5248
US

IV. Provider business mailing address

9755 KALISPELL ST
COMMERCE CITY CO
80022-9338
US

V. Phone/Fax

Practice location:
  • Phone: 480-476-9180
  • Fax:
Mailing address:
  • Phone: 480-334-1373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD011151
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: